Thoracic Epidural Analgesia for Postoperative Pain Management in Liver Transplantation: A 10-year Study on 685 Liver Transplant Recipients

Background and objectivesEffective pain control improves postoperative rehabilitation and enhances recovery. The aim of this review was to evaluate the available evidence and to develop recommendations for optimal pain management after open liver resection using Procedure-Specific Postoperative Pain Management (PROSPECT) methodology.Strategy and selection criteriaRandomized controlled trials (RCTs) published in the English language from January 2010 to October 2019 assessing pain after liver resection using analgesic, anesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane databases.ResultsOf 121 eligible studies identified, 31 RCTs and 3 systematic reviews met the inclusion criteria. Preoperative and intraoperative interventions that improved postoperative pain relief were non-steroidal anti-inflammatory drugs, continuous thoracic epidural analgesia, and subcostal transversus abdominis plane (TAP) blocks. Limited procedure-specific evidence was found for intravenous dexmedetomidine, intravenous magnesium, intrathecal morphine, quadratus lumborum blocks, paravertebral nerve blocks, continuous local anesthetic wound infiltration and postoperative interpleural local anesthesia. No evidence was found for intravenous lidocaine, ketamine, dexamethasone and gabapentinoids.ConclusionsBased on the results of this review, we suggest an analgesic strategy for open liver resection, including acetaminophen and non-steroidal anti-inflammatory drugs, combined with thoracic epidural analgesia or bilateral oblique subcostal TAP blocks. Systemic opioids should be considered as rescue analgesics. Further high-quality RCTs are needed to confirm and clarify the efficacy of the recommended analgesic regimen in the context of an enhanced recovery program.

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Continuous thoracic epidural analgesia compared with intravenous analgesia for postoperative pain management of breast reconstruction with free TRAM flap

European Journal of Anaesthesiology ◽

10.1097/00003643-200406002-00415 ◽

2004 ◽

Vol 21 (Supplement 32) ◽

pp. 114

Author(s):

D. Oroszy ◽

M. Lopuh

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Epidural Analgesia ◽

Breast Reconstruction ◽

Postoperative Pain Management ◽

Thoracic Epidural Analgesia ◽

Tram Flap ◽

Thoracic Epidural ◽

Intravenous Analgesia

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Assessment of postoperative pain management and comparison of effectiveness of pain relief treatment involving paravertebral block and thoracic epidural analgesia in patients undergoing posterolateral thoracotomy

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-0901-3 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Małgorzata Edyta Wojtyś ◽

Józef Wąsikowski ◽

Norbert Wójcik ◽

Janusz Wójcik ◽

Piotr Wasilewski ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Pain Relief ◽

Epidural Analgesia ◽

Postoperative Pain Management ◽

Thoracic Epidural Analgesia ◽

Paravertebral Block ◽

Posterolateral Thoracotomy ◽

Thoracic Epidural ◽

Comparison Of Effectiveness

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01 / Postoperative pain management in thoracic surgery: Paravertebral block versus thoracic epidural.

10.26226/morressier.5aeb0aca07b0d6001a79a7ee ◽

2018 ◽

Author(s):

Manuel Granell Gil

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Thoracic Surgery ◽

Postoperative Pain Management ◽

Paravertebral Block ◽

Thoracic Epidural

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Peritoneal Dialysis After Liver Transplantation: A Systematic Review

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211029722 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110297

Author(s):

Jean Maxime Côté ◽

Isabelle Ethier ◽

Héloïse Cardinal ◽

Marie-Noëlle Pépin

Keyword(s):

Systematic Review ◽

Liver Transplantation ◽

Liver Transplant ◽

Kidney Failure ◽

Liver Graft ◽

Transplant Recipients ◽

Technique Survival ◽

Liver Transplant Recipients

Background: Chronic kidney disease following liver transplantation is a major long-term complication. Most liver transplant recipients with kidney failure will be treated with dialysis instead of kidney transplantation due to noneligibility and shortage in organ availability. In this population, the role of peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) remains unclear. Objective: To determine the feasibility regarding safety, technique survival, and dialysis efficiency of PD in liver transplant recipients requiring KRT for maintenance dialysis. Design: Systematic review. Setting: Interventional and observational studies reporting the use of PD after liver transplantation. Patients: Adult liver transplant recipients with kidney failure treated with maintenance KRT. Measurements: Extracted data included eligibility criteria, study design, demographics, and PD modality. The following outcomes of interest were extracted: rate of peritonitis and microorganisms involved, noninfectious peritoneal complications, technique survival, and kidney transplantation-censored technique survival. Non-PD complications included overall survival, liver graft dysfunction, and hospitalization rate. Methods: The following databases were searched until July 2020: MedLine/PubMed, EMBASE, CINAHL, and Cochrane Library. Two reviewers independently screening all titles and abstracts of all identified articles. Due to the limited sample size, observational designs and study heterogeneity expected, no meta-analysis was pre-planned. Descriptive statistics were used to report all results. Results: From the 5263 identified studies, 4 were included in the analysis as they reported at least 1 outcome of interest on a total of 21 liver transplant recipients, with an overall follow-up duration on PD of 19.0 (Interquartile range [IQR]: 9.5-29.5) months. Fifteen episodes of peritonitis occurred in a total cumulative PD follow-up of 514 patient-months, representing an incidence rate of 0.35 per year. These episodes did not result in PD technique failure, mortality, or impairment of liver graft function. Limitations: Limitations include the paucity of studies in the field and the small number of patients included in each report, a risk of publication bias and the impossibility to directly compare hemodialysis to PD in this population. These results, therefore, must be interpreted with caution. Conclusions: Based on limited data reporting the feasibility of PD in liver transplant recipients with kidney failure, no signal was associated with an increased risk of infectious complications. Long-term studies evaluating this modality need to be performed. Registration (PROSPERO): CRD42020218374.

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Risk factors predicting Cytomegalovirus infection in post liver transplant recipients

QJM ◽

10.1093/qjmed/hcaa052.005 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M G Abdelrahman ◽

H A Mahmoud ◽

M K Mohsen ◽

M O Ali ◽

A M N Mohamed

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

Liver Transplant ◽

Organ Transplantation ◽

Chronic Rejection ◽

Cytomegalovirus Infection ◽

Transplant Recipients ◽

Cmv Infection ◽

Donor Liver Transplantation ◽

Liver Transplant Recipients

Abstract Background Liver transplantation is considered to be the only curative treatment for patients with end stage liver disease. Postoperative infection remains to be one of the most common causes of morbidity and mortality throughout the past years. Cytomegalovirus (CMV) infection although considered to be a weak viral infection that usually passes asymptomatic in immunocompetent patients, however, it is considered one of the most common pathogens causing morbidities and mortality in liver transplant recipients. Multiple studies have been done to assess the risk factors for developing CMV infection. Objective Identification of risk factors predicting Cytomegalovirus infection in liver transplant recipients following transplantation. Methods This retrospective study was conducted on 194 patients and their donors who underwent living donor liver transplantation operation at Ain Shams centre for organ transplantation (ASCOT) at Ain Shams specialized hospital in the period between January 2010 and December 2016 with at least one year follow up period after operation for the recipient group. Results In our study, 194 patients undergoing liver transplantation at Ain shams centre for organ transplantation over seven years from January 2010 to December 2016 have been followed to assess risk factors affecting CMV infection development. Chronic rejection was found to be the most common factor associated with CMV infection followed by Cyclosporin (Neoral) as main postoperative immunosuppressant following liver transplantation. Other factors that were found to carry risk for CMV infection included younger age, advanced MELD score, positive CMV IgM status of the donors and recipients. Conclusion Differentiation of Cytomegalovirus disease from Cytomegalovirus infection isn’t always available as it requires tissue invasive techniques. Multiple risk factors have been attributed to cause Cytomegalovirus infection (viremia) . In our study, rejection (chronic rejection) was the factor that carries highest risk for Cytomegalovirus infection development followed by Cyclosporin .

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